Diseases of the Conjunctiva Practice Questions

Q: Which of the following statements about membranous conjunctivitis is false?

Easy to peel. ***Easy to peel*** - This statement is **FALSE** because **membranous conjunctivitis** forms a **true membrane** that is **firmly adherent** to the conjunctiva and **bleeds upon removal**. - Its firm adherence is due to involvement of the **superficial layers of the substantia propria**, making it **difficult to peel** without causing tissue trauma and bleeding. - This distinguishes it from **pseudomembranous conjunctivitis**, where the membrane is loosely adherent and can be peeled easily without bleeding. *Caused by corynebacterium* - **Corynebacterium diphtheriae** is a classic cause of membranous conjunctivitis, producing a severe inflammatory response through exotoxin production. - Other causes include severe bacterial infections (β-hemolytic streptococci), ligneous conjunctivitis, and severe adenoviral infections. - This statement is TRUE. *May lead to cicatrisation* - The severe inflammatory process involving deeper conjunctival layers leads to **scarring (cicatrisation)** of the conjunctiva. - Complications include **symblepharon** (adhesions between bulbar and palpebral conjunctiva), **entropion**, **trichiasis**, and **fornix shortening**. - This statement is TRUE. *May cause corneal ulceration* - The intense inflammation and toxic products from causative organisms can extend to the cornea. - **Corneal complications** include ulceration, pannus formation, and potential perforation in severe cases. - Secondary bacterial infection can further compromise corneal integrity. - This statement is TRUE.

Q: Which of the following conditions is associated with Stocker's line?

Pterygium. ***Pterygium*** - **Stocker's line** is a characteristic brownish iron deposition line seen at the **leading edge (head) of a pterygium**. - This line is caused by the accumulation of iron within the corneal epithelium due to chronic tear pooling and iron pigment deposition at the advancing edge of the pterygium. - It appears as a **horizontal brownish line** anterior to the pterygium head. *Pinguecula* - A **pinguecula** is a yellow-white patch or bump on the conjunctiva, typically on the nasal side. - It does **not invade the cornea** and therefore does not have an associated Stocker's line. - It represents a **degenerative collagenous change** of the conjunctival stroma with elastotic degeneration. *Fleischer's ring* - **Fleischer's ring** is another type of corneal iron deposition line, but it is associated with **keratoconus**, not pterygium. - It appears as a **brownish ring** at the base of the cone in keratoconus. - This is a distinct clinical entity from Stocker's line and helps differentiate various causes of corneal iron deposition. *Congenital ocular melanosis* - This is a condition of **increased pigmentation of the ocular tissues**, such as the uveal tract or sclera, present from birth. - It is a diffuse pigmentation disorder and does **not involve iron deposition** or the formation of Stocker's line. - Also known as **ocular melanocytosis**, it carries a slight increased risk of uveal melanoma.

Q: Patient developed acute redness of eye with mucopurulent discharge and halos. It did not stain with fluorescein. The halos subsided after washing with clean water and the patient responded to five day course of topical antibiotics. What should be your probable diagnosis?

Acute bacterial conjunctivitis. ***Acute bacterial conjunctivitis*** - The presence of **mucopurulent discharge**, **acute redness**, and "halos" (which can be caused by corneal edema secondary to inflammation) that resolved after washing suggest an infection. - The rapid response to **topical antibiotics** further supports a bacterial etiology, and the lack of fluorescein staining rules out corneal abrasion or ulceration. *Angle closure glaucoma* - While it can cause **halos around lights** and acute redness, it is typically associated with **severe pain**, blurred vision, and a fixed, mid-dilated pupil. - It would not normally present with **mucopurulent discharge** and would not resolve with simple washing or topical antibiotics. *Uveitis* - Uveitis can cause **redness and pain**, but typically presents with **photophobia**, ciliary flush, and often no discharge or a watery discharge, not mucopurulent. - **Halos** are not a typical symptom, and it would not resolve with washing or a short course of topical antibiotics. *Immature senile cataract* - Cataracts cause **gradual, painless vision loss** and **halos around lights** due to light scatter through the cloudy lens. - They do not cause acute redness, mucopurulent discharge, or suddenly resolve with washing.

Q: Features of vernal conjunctivitis are:

All of the options. ***All of the options*** - **Vernal conjunctivitis (VKC)** is a severe form of allergic conjunctivitis characterized by chronic inflammation of the conjunctiva, impacting the cornea in advanced stages. - **Shield ulcers**, **Horner-Trantas dots**, and **papillary hypertrophy** are all classic clinical features observed in VKC. *Shield ulcer* - This is a **corneal complication** of severe vernal conjunctivitis, characterized by epithelial defects that can lead to significant pain and vision impairment. - It develops due to corneal abrasion from the giant papillae on the upper tarsal conjunctiva and direct corneal toxicity from inflammatory mediators. *Horner-Trantas spots* - These are **gelatinous aggregations** of epithelial cells and eosinophils that appear as white dots at the limbus, particularly evident at the superior limbus. - They are one of the **pathognomonic signs** of vernal conjunctivitis, indicating significant allergic inflammation. *Papillary hypertrophy* - Characterized by the development of **large, flattened papillae** (often described as "cobblestone" papillae) on the upper tarsal conjunctiva. - This hypertrophy is a result of chronic inflammation and proliferation of mast cells, eosinophils, and lymphocytes in the conjunctival stroma.

Q: Which of the following is NOT a characteristic feature of Trachoma?

Ectropion of upper eyelids. ***Ectropion of upper eyelids*** - **Ectropion** is the outward turning of the eyelid, which is not a characteristic feature of trachoma; instead, **entropion** (inward turning) is common due to scarring. - This condition specifically affects the **lower eyelids** more often when it occurs due to aging, not the upper eyelids as a primary feature of trachoma. *Conjunctival scarring* - **Conjunctival scarring** is a hallmark of chronic trachoma, often leading to severe complications like entropion and trichiasis. - The repeated inflammation caused by *Chlamydia trachomatis* infection damages the conjunctival tissue, resulting in fibrotic changes. *Follicular conjunctivitis* - **Follicular conjunctivitis** is an early and characteristic sign of active trachoma, particularly in its inflammatory stages. - The formation of lymphoid follicles on the tarsal conjunctiva is a direct immune response to the *Chlamydia trachomatis* infection. *Corneal pannus* - **Corneal pannus**, characterized by superficial vascularization and connective tissue growth over the cornea, is a common feature of advanced trachoma. - This chronic inflammatory process often leads to **corneal opacification** and can result in significant vision impairment or blindness.

Q: A malnourished child from a poor socioeconomic status, residing in overcrowded and dirty areas, presents with a nodule around the limbus and hyperemia of the surrounding conjunctiva in his left eye, as well as axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis?

Phlyctenular conjunctivitis. ***Phlyctenular conjunctivitis*** - This condition is an immune-mediated hypersensitivity reaction to a foreign antigen, often associated with systemic diseases like **tuberculosis** or **Staphylococcus aureus** infection, commonly seen in malnourished children from poor socioeconomic backgrounds. - The characteristic lesion is a **nodule (phlyctenule)** near the **limbus** with surrounding conjunctival hyperemia, which aligns with the child's presentation. *Foreign body granuloma* - A **foreign body granuloma** is a reaction to a foreign material embedded in the conjunctiva or sclera, typically caused by trauma or an identifiable foreign object. - It does not explain the concurrent **axillary and cervical lymphadenopathy** or the association with malnutrition and poor hygiene. *Vernal keratoconjunctivitis* - **Vernal keratoconjunctivitis** is a chronic, bilateral allergic disorder, primarily affecting children and young adults, often seasonal and related to atopy. - It is characterized by **giant papillae on the tarsal conjunctiva** and often forms a **Trantas dot** on the limbus, which are different from a single limbal nodule and not typically associated with lymphadenopathy or socioeconomic factors in this way. *Episcleritis* - **Episcleritis** is an acute, self-limiting inflammation of the episcleral tissue, presenting as **sectoral or diffuse redness** and mild discomfort. - It does not involve a distinct nodule around the limbus or systemic symptoms like **lymphadenopathy**, nor is it directly linked to malnutrition or poor hygiene.

Q: Inclusion conjunctivitis is caused by:

Chlamydia trachomatis. ***Chlamydia trachomatis*** - **Inclusion conjunctivitis** is primarily caused by **Chlamydia trachomatis serovars D-K**. - This form of conjunctivitis is characterized by follicular response and cytoplasmic inclusions seen in epithelial cells. *Klebsiella species* - **Klebsiella** are common bacteria that can cause a variety of infections, including pneumonia and urinary tract infections. - While they can cause conjunctivitis, it is typically a bacterial conjunctivitis and not specifically referred to as inclusion conjunctivitis. *Adenovirus* - **Adenoviruses** are a common cause of **viral conjunctivitis**, which often presents with watery discharge and pharyngitis. - Unlike *Chlamydia*, adenovirus infections do not form characteristic cytoplasmic inclusions in conjunctival cells. *Mycobacterium Leprae* - **Mycobacterium leprae** is the causative agent of **Leprosy**, a chronic infectious disease primarily affecting the skin, nerves, and upper respiratory tract. - It does not directly cause conjunctivitis as its primary manifestation, although ocular complications can occur in advanced leprosy.

Q: Cobblestone appearance of the conjunctiva is typically seen in which of the following conditions?

Vernal keratoconjunctivitis. ***Vernal keratoconjunctivitis*** - This condition is characterized by **large, flattened papillae** on the upper tarsal conjunctiva, which give it a classic **cobblestone appearance**. - It is a severe, chronic form of **allergic conjunctivitis**, often seen in children and young adults, associated with severe itching and seasonal recurrence. *Allergic conjunctivitis* - While it involves allergic reactions and sometimes papillae, the term **"cobblestone appearance"** specifically refers to the **large, flat papillae seen in Vernal Keratoconjunctivitis**, not general allergic conjunctivitis. - General allergic conjunctivitis often presents with **diffuse papillary hypertrophy** but not typically the characteristic cobblestoning unless it progresses to the chronic, severe form. *Chlamydial conjunctivitis* - This is primarily associated with **follicles** on the conjunctiva, particularly in the lower fornix, rather than a cobblestone appearance. - It is an **infectious condition**, often linked to sexually transmitted infections, and its conjunctival findings are distinct from allergic forms. *Giant papillary conjunctivitis* - While it features **giant papillae** (similar to those causing the cobblestone appearance), it is typically caused by mechanical irritation from **contact lenses** or ocular prostheses, not a primary allergic etiology like VKC. - It often affects the **upper tarsal conjunctiva** but is usually unilateral or asymmetrical and directly related to a foreign body.

Q: Which of the following is a characteristic feature of trachoma?

Herbert's pits in the limbus. ***Herbert's pits in the limbus*** - **Herbert's pits** are **pathognomonic** (uniquely characteristic) depressions formed at the limbus due to the healing of active limbal follicles in **trachoma**. - Their presence indicates past or chronic **Chlamydia trachomatis** infection and distinguishes trachoma from other causes of follicular conjunctivitis. - This is the **most specific** diagnostic feature of trachoma. *Corneal neovascularization (pannus)* - While **superior corneal pannus** (neovascularization extending into the cornea from above) can occur in chronic trachoma, it is **not specific** to trachoma. - Pannus is also seen in **vernal keratoconjunctivitis**, **contact lens overwear**, and other chronic inflammations. - It represents chronic inflammation but is not unique to trachoma as a primary diagnostic feature. *Epithelial keratitis* - **Epithelial keratitis** involves inflammation of the corneal epithelium and is a **non-specific finding** in many eye conditions, including viral infections, bacterial keratitis, and dry eyes. - Although it can occur in trachoma, it is not a characteristic or specific feature for diagnosis. *Follicle formation in the conjunctiva* - **Follicle formation** in the upper tarsal conjunctiva is seen in active trachoma (**trachomatous inflammation—follicular, TF**) in the early stages. - However, follicular conjunctivitis is **not specific** to trachoma—it also occurs in **viral conjunctivitis** (adenovirus), **inclusion conjunctivitis** (Chlamydia in neonates/adults), **molluscum contagiosum**, and drug reactions. - While important for staging active disease, follicles alone cannot differentiate trachoma from other causes, making **Herbert's pits** the more characteristic diagnostic feature.

Question 1

Which of the following statements about membranous conjunctivitis is false?

Accepted Answer

Easy to peel

Answer

Caused by corynebacterium

Answer

May cause corneal ulceration

Answer

May lead to cicatrisation

Question 2

Which of the following conditions is associated with Stocker's line?

Accepted Answer

Pterygium

Answer

Pinguecula

Answer

Fleischer's ring

Answer

Congenital ocular melanosis

Question 3

What does the Phenol red thread test assess in relation to dry eye?

Accepted Answer

Colour change on contact with tears to assess the volume of tears

Answer

Uses a pH meter for measurement and interpretation

Answer

Measures ocular surface mucin deficiency if thread colour changes to blue

Answer

Requires instillation of topical anesthesia before the procedure

Question 4

Patient developed acute redness of eye with mucopurulent discharge and halos. It did not stain with fluorescein. The halos subsided after washing with clean water and the patient responded to five day course of topical antibiotics. What should be your probable diagnosis?

Accepted Answer

Acute bacterial conjunctivitis

Answer

Immature senile cataract

Answer

Uveitis

Answer

Angle closure glaucoma

Question 5

Features of vernal conjunctivitis are:

Accepted Answer

All of the options

Answer

Papillary hypertrophy

Answer

Horner-Trantas spots

Answer

Shield ulcer

Question 6

Which of the following is NOT a characteristic feature of Trachoma?

Accepted Answer

Ectropion of upper eyelids

Answer

Follicular conjunctivitis

Answer

Corneal pannus

Answer

Conjunctival scarring

Question 7

A malnourished child from a poor socioeconomic status, residing in overcrowded and dirty areas, presents with a nodule around the limbus and hyperemia of the surrounding conjunctiva in his left eye, as well as axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis?

Accepted Answer

Phlyctenular conjunctivitis

Answer

Foreign body granuloma

Answer

Vernal keratoconjunctivitis

Answer

Episcleritis

Question 8

Inclusion conjunctivitis is caused by:

Accepted Answer

Chlamydia trachomatis

Answer

Klebsiella species

Answer

Mycobacterium Leprae

Answer

Adenovirus

Question 9

Cobblestone appearance of the conjunctiva is typically seen in which of the following conditions?

Accepted Answer

Vernal keratoconjunctivitis

Answer

Allergic conjunctivitis

Answer

Chlamydial conjunctivitis

Answer

Giant papillary conjunctivitis

Question 10

Which of the following is a characteristic feature of trachoma?

Accepted Answer

Herbert's pits in the limbus

Answer

Epithelial keratitis

Answer

Corneal neovascularization (pannus)

Answer

Follicle formation in the conjunctiva

Diseases of the Conjunctiva — MCQs

Diseases of the Conjunctiva — MCQs

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